From the Research
Tinea versicolor is most effectively treated with topical antifungal therapy, which has a better safety profile and lower cost compared to systemic treatment, and is therefore the treatment of choice. For mild to moderate cases, topical treatments are typically used first, including:
- Selenium sulfide shampoo (2.5%) applied to affected areas for 10 minutes daily for 7 days
- Antifungal creams containing clotrimazole, ketoconazole, or miconazole applied twice daily for 2-4 weeks These treatments are effective against the Malassezia yeast that causes tinea versicolor, which can proliferate under certain conditions like heat, humidity, and oily skin 1. For more extensive or stubborn infections, oral antifungal medications may be prescribed, such as:
- Fluconazole (400mg as a single dose or 150mg weekly for 2-4 weeks)
- Itraconazole (200mg daily for 5-7 days) However, oral antifungal therapy is typically reserved for patients with extensive disease, frequent recurrences, or disease that is refractory to topical therapy, due to its higher cost, greater adverse events, and potential drug-drug interactions 1. During treatment, patients should avoid excessive heat and sweating as these can worsen the condition. It's also important to note that even after successful treatment, skin discoloration may persist for weeks or months until the skin naturally repigments. Long-term intermittent prophylactic therapy should be considered for patients with frequent recurrence of the disease, to prevent recurrent infection 2. Selection of antifungal agents depends on several factors, including efficacy, safety, local availability, ease of administration, likelihood of compliance, and potential drug interactions of the antifungal agent 1.